This is a fully remote position, open to applicants in United States.

📋 Description

• Process healthcare claims assigned to you according to client-defined guidelines or directives from team leaders.

• Achieve productivity goals along with financial and procedural accuracy standards set by management.

• Evaluate claims-processing-system data to ascertain the appropriateness of services and verify benefit coverage requirements.

• Examine adjudication-system edits to decide on the payment of claims and/or individual line items.

• Provide mentorship to junior team members.

• Collaborate on special initiatives, such as process documentation, training, quality audits, and surge activities.

• Communicate with management regarding any issues or concerns and implement preventive measures to ensure accuracy and quality in processing.

• Engage in projects related to provider data, authorizations, enrollment, or other designated tasks.

• Report directly to the Claims Team Leader.

⛳️ Requirements

• High School diploma is mandatory.

• 1–3 years of experience in healthcare claims processing is required.

• Strong understanding and capability to analyze claim data.

• Familiarity with physician practices, hospital coding, billing, and medical terminology.

• Knowledge of CPT, HCPCS, ICD-10, UB04, CMS 1500, authorizations, and general healthcare concepts.

• Proficiency in ICD-10, CPT, and HCPCS coding is an advantage.

• Willingness to acquire new skills.

• Ability to collaborate effectively within a team.

• Strong work ethic is essential.

• Capability to adapt swiftly to a dynamic work environment.

• Self-motivated and quick to learn.

• Ability to work collaboratively.

• Candidates may need to undergo a pre-employment criminal background check.

🏝️ Benefits

• Remote work setting.

• Potential travel may be required based on company needs.

• Reasonable accommodations available for individuals with disabilities.

• Equal opportunity employer dedicated to workforce diversity.